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5 Ways to Reduce Nursing Turnover in Year One

Turnover among first-year nurses remains a huge cost driver and source of frustration for hospital managers. It’s hard enough to find these skilled clinicians, and even more annoying that they quit, just when they should be settling into their new careers. That leaves harried HR staff to start the process anew and with no more assurances of retaining the next new recruit.

Beyond the hard-and-fast cost of finding and on-boarding replacements or hiring temps, first-year nurse turnover impacts patient care. It also signals larger workforce management issues, most notably a failure to effectively engage employees and sell them on the mission.

There are theories about why first-year nurses quit. Perhaps some of these new nurses weren’t trained well in school, a cold fact that comes home quickly in the life-and-death hospital setting. Some new nurses probably have unrealistic expectations that collide with on-the-job realities. Some nurses get better offers elsewhere for their high-in-demand skills. Maybe, just maybe, your hospital is not a good place to work. Whatever the reason, the problem persists.

If it’s any consolation, Shebani Patel, a director with PwC Saratoga, the workforce research arm of PricewaterhouseCoopers LLP, says retaining new workers is a challenge not unique to healthcare.

“First year turnover tends to be the most problematic length of service for most organizations across most industries,” she says. “What is occurs is the assimilation process -- that is really critical for organizations -- but sometimes the goal is just filling positions and getting people in the door and the steps aren’t always done in the best way possible.”

”With this economy, what we have experienced is a nurse gets an offer they are going to take it. But if there is a lot of competition in the area, they are going to take the job to get the experience and then jump at the next best offer,” Patel says.

PwC Saratoga found that first-year nursing turnover can run as high as 60% in some of the 40 healthcare systems that participate in its Human Capital Effectiveness Benchmarking Report. The median first-year turnover was 17.1% for the report’s “best practices” health systems, and PwC Saratoga interviewed them to find a common theme for their relatively successful nurse retention.



Here’s what they found:

1. Schedule competency-based interview processes and selection testing that includes cultural fit.

Best practice hospitals use competency-based interviews/selection testing based on a standard set of questions to identify qualities and skills. One system grades “B” or “C” level candidates for certain roles but must hire only “A” candidates for others. These systems have found a correlation between those who meet the requirements of the upfront selection process and lower turnover

2. Build relationships with nursing schools and a robust nurse resident program.

Hospitals with nurse resident programs swear by them. Nurses hired from these programs are generally strong performers because the systems assess their clinical performance before hiring them. These nurses are also less likely to leave because they are familiar with the culture. One health system fills most of its nursing slots from its nurse resident program, which pays for participants’ tuition. The program begins after the first quarter of school and offers flexible hours. New nurses attend orientation and are partnered with preceptors. Another system offers outreach to nursing graduates, including a forum for nurse graduates to network and stay connected as they look for jobs. The system beats competitors by strengthening its pipeline of potential candidates and developing its employer brand.

3. Conduct extensive orientation followed by employee feedback.

New nurses are encouraged to maintain contact with and provide feedback to human resources staff through orientation programs that last up to a full year. Orientation may be customized by department/unit, and touch points typically occur after 30/45 and 90 days, six months, and a year. One system offers a week of orientation and follow-up with the same group of employees at 45 days and 90 days. At 45 days, nurses complete a satisfaction questionnaire. Another system conducts “re-interviews” at three and 10 months to ensure nurse satisfaction and fit. One system hosts reunions for recent hires at four months and a year and offers off-site retreats by nursing unit. Another system has recent hires lunch with the hospital president after one month and one year.


4. Implement new hire support programs.

Systems link new nurses to non-supervisor “buddies” who provide confidential support and guidance. One system offers a nurse retention contact on HR staff who provides a “safe haven” where employees can air concerns.

5. Track and measure criteria that to drive accountability.

Successful systems use metrics to drive retention. One system tracks data on turnover, engagement, and patient satisfaction on a unit level, and will intervene for units that do not meet the metrics. Another system measures key performance indicators that reflect retention, such as patient satisfaction. Managers select indicators each year, and attainment is tied to a bonus-sharing program.

Patel says accountability is a common theme for all hospitals with high retention rates. “There is a drive to be measurement oriented,” she says. “Management owns this. They believe that their management is a huge contributing force toward retaining talent.”

Obviously, different hospitals face different challenges, but Patel says good management has been shown to overcome outside pressures beyond the hospital walls. “I talked to organizations – and not just in healthcare – where there is high turnover versus those who have a low turnover and you can definitely tell there is a difference between the programs,” she says. “The way they speak about their programs, the depth of their programs and how they manage the new hires, there is a difference.”

- John Commins, for HealthLeaders Media



Suggestions to control turnover in Nursing.

• Hospital managers should empower their staff and give them more autonomy, more control, and improved work climates

• Implementation of a work team model within hospitals might enhance the input and involvement of clinical nurses in decision-making

• Self-leadership may give the employee stronger feelings of competence, purpose, self-control, and mental job redesign. This may raise the employee’s job satisfaction and decrease turnover intention

• Job information and support from supervisors may reduce work stress

• Support from coworkers also may reduce turnover

• Hospital managers or nurse supervisors should seek ways to offer clinical nurses more social support and practical assistance at work, for example, providing sufficient information and resources to enhance decision-making, offering more task-relevant feedback and praise, listening to nurses’ opinions, and showing concern for their daily work

• Access to mentors with whom to share their experiences and seek advice is an important social support for novice nurses.

To learn of other ways to help maintain a safe and happy staff call 1-866-633-3548 or visit us at


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